Hyperkalemia in pediatric chronic kidney disease

for the CKiD Study Investigators

Research output: Contribution to journalArticlepeer-review


Background: While hyperkalemia is well described in adult chronic kidney disease (CKD), large studies evaluating potassium trends and risk factors for hyperkalemia in pediatric CKD are lacking. This study aimed to characterize hyperkalemia prevalence and risk factors in pediatric CKD. Methods: Cross-sectional analysis of Chronic Kidney Disease in Children (CKiD) study data evaluated median potassium levels and percentage of visits with hyperkalemia (K ≥5.5 mmoL/L) in relation to demographics, CKD stage, etiology, proteinuria, and acid–base status. Multiple logistic regression was used to identify risk factors for hyperkalemia. Results: One thousand and fifty CKiD participants with 5183 visits were included (mean age 13.1 years, 62.7% male, 32.9% self-identifying as African American or Hispanic). A percentage of 76.6% had non-glomerular disease, 18.7% had CKD stage 4/5, 25.8% had low CO2, and 54.2% were receiving ACEi/ARB therapy. Unadjusted analysis identified a median serum potassium level of 4.5 mmol/L (IQR 4.1–5.0, p <0.001) and hyperkalemia in 6.6% of participants with CKD stage 4/5. Hyperkalemia was present in 14.3% of visits with CKD stage 4/5 and glomerular disease. Hyperkalemia was associated with low CO2 (OR 7.72, 95%CI 3.05–19.54), CKD stage 4/5 (OR 9.17, 95%CI 4.02–20.89), and use of ACEi/ARB therapy (OR 2.14, 95%CI 1.36–3.37). Those with non-glomerular disease were less frequently hyperkalemic (OR 0.52, 95%CI 0.34–0.80). Age, sex, and race/ethnicity were not associated with hyperkalemia. Conclusions: Hyperkalemia was observed more frequently in children with advanced stage CKD, glomerular disease, low CO2, and ACEi/ARB use. These data can help clinicians identify high-risk patients who may benefit from earlier initiation of potassium-lowering therapies. Graphical Abstract: [Figure not available: see fulltext.].

Original languageEnglish (US)
Pages (from-to)3083-3090
Number of pages8
JournalPediatric Nephrology
Issue number9
StatePublished - Sep 2023


  • Hyperkalemia
  • Pediatric chronic kidney disease

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health


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